A 12 months follow up appointment was held over the phone today. Patient had diffused thinning throughout the top half of his head with persistent frontal forelock hairs. From the front, his loss was difficult to assess but top and side views reveal his hair loss in better detail. Since the patient is in his mid 20’s, Dr. Ron Shapiro took the cautious approach (hairline was not brought down, coverage addressed a large area). And, the patient was made aware of the risks of shock loss and possible future ht work if hair loss progressed.

With his results from SMG and his daily regimen to keep his native hairs, he is absolutely thrilled with the coverage, density and naturalness. If he does lose more, he stated he’d gladly come back to SMG.

We chatted about the effectiveness of the low level laser. He felt the laser along with Propecia worked well to keep his native hairs. The typical 14-15 shed hairs he used to see in the mornings dwindled down to 5-6 hairs. We’re pleased he has not noticed further hair loss progression and that he couldn’t be happier with his HT results.

A request for more pics of this patient with wet hair was asked on HLH. This patient has been more than gracious to send variety of pics, including the new pics with wet hair. We need more patients like him......hint, hint to those of you who keep putting me off on this.

Hey Janna, I know this is an old result but I noticed this patient was using low level laser. Do you know if Dr. Ron recommends the laser comb to his patients? Or does he think the Capillus cap is better? The price tag between the two is a bit steep and was wondering what the major differences were. Thanks!

I can't give you a definitive answer about laser treatment. It has been used now for many years and there are a lot of studies that show it can be effective...sometimes as much as Rogaine. So I think it works for some people. But there are others that feel it does not. Therefore the only way to know for an individual is to try it themselves for at least 6 months and see if it works for them. That is not a great option but the only one that will really let you know if you are responsive.

If you do not show improvement then you can make your own judgment. However, there will be those that say ...not progressing is actually a benefit....but unless you were progressing fast it is hard to know if this is occurring.
As far as if the more expensive lasers work better is questionable. They have more power, but you are only supposed to use the laser for 20 -30 minutes 3 times a week so I don't know.
With respect to cost, if the laser works you would use it for life so it turns out over the long haul not to be so expensive. If you use it for 1 year, a $2000 laser is ~$3 per day. Do you have family members who can share and share the cost? If you try it and don't like it, it is a loss of money.

Bottom line is that if it is a financial stress you may want to start with the less expensive ones. If you have the extra money you can try this. I do think it is worthwhile to try something if you are worried.

It is my belief that the relative effectiveness of different medical therapies is as follows:

1. Propecia or finasteride is the best with 90 percent of patients getting some degree of regrowth or the prevention of progression. At least 50 percent of those have very significant regrowth. Of course, the risk of the side effects ( a controversial subject) has led many to not take or stop this medication. It is unfortunate as there is no question this medication works well. A patient has to decide if it worth the risk for him to try. This is the topic of another subject and I won't comment more here. I will leave a link to Dr. Robert Bernstein’s website that goes to his page where he has over 140 examples of patients who we treated with Propecia and Rogaine alone. I think it is a good page for patients to see if they truly want to know how beneficial Propecia could be to them. However once again…due to the potential side effect …even if it is a low risk a patient has to decide what is more important to them…. More hair or not taking the risk of the side effects. We can only give them the data.

One other point. Propecia is now available in a topical form and a few companies …especially one in Italy has developed a delivery system that supposedly limits systemic absorption and keeps most of the product local. So for those that are afraid of the side effects at the typical 1mg orally per day, an alternative method could be the topical …or going to a lower dose oral regime of 1 mg 3 times a week….which is suppose to be ~80 percent as effective as the regular dose…so still good.

2. Rogaine (Minoxidil) is also definitely effective. It is the second best. It is not as powerful as Propecia but at least 50 percent of people have either some regrowth or a slowing of the hair loss. The degree of regrowth is not as much. For about 30 percent of those that respond it is very very good…but for the rest it is milder. And 30 percent of people do not have any benefit. There is a new (actually old) way to prescribe this medication by pill and we think it may be more effective and obviously simpler to take than applying lotion every night. It has been used this way in Asia for over 20 years with good results. The risk of side effects appears to be low. Minoxidil used to be used as a BP medication at dose of 20 -100 mg per day and the side effects that are in the literature have mostly to do with those doses. At the dose used for hair growth. 1.25 mg to 2.5 mg which is much lower these side effects have do not seem to be an issue. So for those that don’t take3 rogaine due to it being messy, this is an option now.

3. Laser therapy is the third best. I think in some people it is as good as rogaine. But in others not. Unfortunately unpredictable.

I think combined therapy is more effective than single therapy as they all work by different mechanisms.

Thanks for your response Dr. Ron. I guess like all things what works for one patient may not work for another and vice versa. I think I'm going to give the Hairmax laser comb a whirl. Worst case scenario is that it doesn't work and I return it for a refund. I already use rogaine foam and a dht blocker along with Nizoral once a week so this will be another good addition to my regimen. For whatever reason my frontal 1/3 seems to be the most resistant in terms of responding to medical therapy.

I THINK THE HAIR MAX[ WHICH WAS THE ORIINAL LASER] IS ONE OF THE BEST AND MOST AFFORDABLE. THIER NEW LASER BAND IS FAST AND EFECTIVE BECAUSE IT SEPARATES THE HAIR TO MAKE SURE THE LIGHT REACHES THE SCALP

Both Propecia and Rogaine work on the entire recipient area front and crown, But it probably is less dramatic in the front because more hairloss has already occurred there. It work best on miniaturized hairs so if one starts earlier the effects are better everywhere. If one has already gone"bald" in an area it can still help but much less dramatically.

So in general we see more effect in the crown because most people use it with early thinning. I guess that means the answer is yes.